Congenital clubfoot

Epidemiology and associated conditions

Congenital clubfoot holds a leading position among all congenital skeletal deformities. Bilateral involvement of the lower extremities is registered significantly more often than unilateral. In most cases, a clear hereditary predisposition transmitted across generations can be traced.

It is important to note that in approximately 10% of patients, clubfoot does not occur in isolation. It may be accompanied by other severe musculoskeletal disorders, such as:

• Congenital hip dislocation;
• Congenital muscular torticollis;
• Scoliotic spinal deformity.

Etiology and pathogenesis of the deformity

Specialists agree that the malformation originates in the initial phase of embryonic development. Modern orthopedics considers two main theories regarding the origin of the pathology:

1. Genetic theory. Suggests that the disease is based on a primary genetic defect that leads to improper tissue formation in the fetus.
2. Mechanical theory. Considered the most well-founded. According to it, the main cause is the negative impact of external mechanical factors on the fetus during a normally progressing pregnancy (while the influence of heredity is not excluded either).

Mechanism of development: Normally, the embryonic foot passes through the physiological stage of equinovarus. If an unfavorable external factor acts on the fetus precisely at this moment (at the 5th–6th week of pregnancy), normal development is disrupted, and the physiological position of the foot becomes fixed, developing into a persistent pathology.

Clinical classification

Assessment of the severity of congenital clubfoot is based on two key criteria: the possibility of performing passive movements in the ankle joint and the degree of effort required to correct the deformity.

There are three main forms:

• Mild form: Characterized by the preservation of free range of motion in the ankle joint. The malpositioned foot is easily correctable without applying gross physical force.
• Moderate form: The range of motion in the joint is noticeably limited. When attempting to manually correct the foot deformity, the physician feels pronounced springy resistance of the tissues.
• Severe form: Characterized by rigid fixation of the foot and a sharp limitation of mobility (requires complex serial or surgical treatment).

Management of patients with concurrent hip dysplasia

Since every tenth child with clubfoot has a concurrent congenital hip dislocation or subluxation, early diagnosis is extremely critical.

To assess the condition of the hip joints, the following are used:

• Ultrasound: The method of choice in the first months of life (no radiation exposure, but requires high diagnostic qualification).
• Radiography: Hilgenreiner's method is used to calculate acetabular indices.
• CT and arthrography: Allow a detailed assessment of bone structures and soft tissues for surgical planning.

Treatment of associated dysplasia begins in the first days of life (wide swaddling, later — Pavlik harness). Rotational movements, hip adduction, and forceful abduction are strictly prohibited — this stretches the joint capsule and can cause painful contracture. In neglected cases (late diagnosis), serial functional plaster casts (e.g., according to Ter-Egiazarov-Sheptun), overhead traction, or surgical interventions (acetabuloplasty, osteotomies) are used.

Briefly: answers to topical questions

Class and exam questions

What else to study on this topic

• Clinical presentation and criteria of severe congenital clubfoot.
• Conservative methods of clubfoot correction (Ponseti method).
• Hilgenreiner's line: construction rules and radiographic indices.
• Indications and technique for applying the Ter-Egiazarov-Sheptun plaster cast.
• Surgical correction of neglected forms of hip dislocation in children over 4 years of age.

Other Topics in "Orthopedics"

Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.